QM Case History: Triglycerides – Lower to Prevent Heart Disease

‘Tom’ asks: How Much Do I Have to Change to Get to Peak Health?


Everybody wants Peak Health. Who wouldn’t? But everyone wants it at the cheapest possible price. I suppose this is human nature. I am always getting the question: How much do I have to change or give up to get to Peak Health?

I don’t know the answer in advance. But, using Quantitative Medicine I can determine it. There are many key numbers that drive health, and triglycerides, which is basically circulating fat, is an important one. In fact, for heart disease, it used to be the most important one, but got shoved aside when the ‘lowest LDL cholesterol at all costs’ craze hit 20 years ago.

Overall LDL cholesterol is unimportant. Since you might think you heard that one wrong, let me repeat: Overall LDL cholesterol is unimportant. Your body will make the LDL it thinks is optimum. Meddling with it always has negative consequences. What is very important, though, is LDL particle size. If it is too small, called pattern ‘B’, it tends to get behind arteriy walls and cause heart disease. If it is big enough, known as pattern ‘A’, it can’t, and you are at low risk.

So a key health question is: “How do I get pattern “A”?” It turns out that if triglycerides are below a certain level, you will get pattern “A”, and if above it, pattern “B”. But what is this magic level? Well, that’s the big question. If you know the right level, you could, in principle, give up just enough of your favorite starchy food, or exercise just a bit harder, and maintain that triglyceride number below your personal key level, and you would then get the heart disease sparing “A” pattern. Of course, you should actually push safely beyond the critical threshold. Things aren’t quite this black and white.

Figuring out that key level is easy to do if you use principles from Quantitative Medicine. Here is an example from my practice.

QM Example Panel

 The patient, whom we’ll call Tom, ‘presented’ with a very high and very unhealthy triglyceride level, well over 200. His particle size pattern was, not surprisingly, “B”, indicating high risk for heart disease. Tom was very committed, modified his diet, began a serious exercise program, and rapidly drove his triglycerides below 100. His pattern flipped to an “A”. Great. You can see this on the right hand graph, where his triglycerides in late 2005 went rapidly down to around 75 by March 2006. On the left hand graph, he popped to an “A” around the same time.

But Tom wanted a ‘bargain’, so he slacked off a bit and hoped for the best. His triglycerides crept up to around 125 in late 2006. This was too high for Tom. His pattern flipped back to a “B”. He coasted along for a year like this, with his triglycerides around 125, 150, and his pattern flipping between “B” and the intermediate “AB” range (meaning both little and big particles were observed).

In early 2007, Tom again made efforts to drive his triglycerides down, and by spring, had the number below 100. His particle size flipped back to the desirable “A” pattern. In 2008, Tom again let the triglycerides go up, flipping back to the “B” pattern.

So Tom may not be willing to do it – that is a different matter – but he is certainly well ‘Quantified’. The key triglyceride level for Tom is a little below 100. When he is below 100, he has the healthy “A” pattern size. Above, he heads toward a “B”.

This is Tom’s key level, not mine or yours. Yours could be as high as 150, or as low as 50. Using the principles of Quantitative Medicine, you can figure it out very precisely. You can explore the unique to you interplay between starches and alcohol for example and get a precise description of what would create a stable triglyceride level and thus uniformly large particle LDL pattern.

Why do triglycerides affect particle size so directly? There’s a very good explanation for this. Stay tuned.

  5 comments for “QM Case History: Triglycerides – Lower to Prevent Heart Disease

  1. Joanna
    February 12, 2015 at 9:47 pm

    This is a fantastic website; it has really helped me to understand the reality of how my body works.

  2. Karen
    March 1, 2015 at 9:09 pm

    I have hereditary high cholesterol usually around 11-13. I am not keen on taking drugs for this and am otherwise healthy and fit. I train 5-6 days a week in weight training and cardio and have a pretty healthy diet. What would you suggest I take as the doctors keep putting pressure for me to take statins . Regards Karen

    • March 4, 2015 at 2:38 pm

      Hi Karen,
      I must confess that this is not enough information for me to provide any guidance. As an aside my Mother’s ran in the same range, she never took any medication for anything, and she lived well into her 90’s with no strokes or heart disease. I mention this not as specific reassurance for you but to illustrate how the numbers themselves do not provide much guidance; in that light don’t let anyone urge you to take medication without further evidence of disease or consequence on that basis. What is your coronary calcium score for example? I didn’t seem to get this particular gift from my Mom. She was a heavy smoker too. Wouldn’t you know, I got hereditary emphysema from my Dad and I never smoked. Besides the personal disclosures I am reinforcing the role of genetics in the story and why ‘just treat the number,’ or at least this particular number, is a bad idea. Dr. Mike

  3. Tom Forsythe
    November 20, 2015 at 7:34 am

    In your piece on Triglycerides, you suggested we continue to compare our triglyceride scores with our LDL scores so I did. I was amazed that in the last 6 blood-work that had been done on me, the ratio of tri’s to LDL was remarkably consistent: roughly a .52 correlation (63 tri–134 LDL; 59 tri–109 LDL; 62 tri–120 LDL; 60 tri–113 LDL; 59 tri–110 LDL; 60 tri–119 LDL). Of course, my doctor continues to tell me my LDL is too high and suggests statins but I have refused him. And yes, several years ago my tri’s were high (100-range) but to lose weight, I greatly reduced my carb intake, eliminated sugar other than that found in natural foods, all alcohol, and lo-and-behold, my weight and triglycerides dropped drastically. My only concern now is whether my LDL readings represent your “A” or “B” pattern.
    Thank you so much for your illuminating work that we common folk can understand at the “101” level. Obviously, I’m a big fan–and so is my wife!

  4. Asha
    January 30, 2016 at 10:49 am

    About Triglyceride I found it very informative I had HDL and LDL
    and for long time I have been having statins. On learning on
    net I asked my Dr about my cholesterol he told me its normal
    when I asked to stop he said I can’t its bz of med you are taking
    if you stop you will suffering more. Do you think I should stop
    taking statins?
    I have few health issues can I send you by email can you please
    help me. I love the way you explain. God bless you for helping
    People in need.

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